Provider Demographics
NPI:1447388897
Name:JOHNSON, CRIST E (DDS)
Entity Type:Individual
Prefix:DR
First Name:CRIST
Middle Name:E
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:330 LOVELL ST
Mailing Address - Street 2:P.O. BOX 37
Mailing Address - City:IONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48846-9706
Mailing Address - Country:US
Mailing Address - Phone:616-527-3460
Mailing Address - Fax:616-527-6349
Practice Address - Street 1:330 LOVELL ST
Practice Address - Street 2:
Practice Address - City:IONIA
Practice Address - State:MI
Practice Address - Zip Code:48846-9706
Practice Address - Country:US
Practice Address - Phone:616-527-3460
Practice Address - Fax:616-527-6349
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010122421223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice